Hysterectomy refers to surgery to remove the female internal sex organs. This surgical operation is often indicated in a woman suffering from cancer of the uterus and/or ovaries. But it is also an operation that is practiced as part of the transition of a transgender man.

This operation is not desired by all transgender men. It should be kept in mind that following this operation the person will be permanently sterile.

Some men will only wish to remove the uterus (hysterectomy), ovaries (oophorectomy) and fallopian tubes (salpingectomy) or only one of the two organs.

Everyone is free to choose the surgery they want, just as they are free not to choose any. It all depends on how each person feels about their body. The only thing necessary is that each person feels good in their body. It is above all a question of feelings.

You should still know that in case of total hysterectomy, the regulation of hormonal treatment will be much easier.

The different surgical techniques

There are three surgical techniques: upper, laparoscopic and lower. Anesthesia is local or general.

1. Upper hysterectomy or laparotomy (abdominal incision)

The incision is either vertical or horizontal. It measures between 10 and 15 cm. The horizontal incision is made just above the pubis while the vertical is made from the base of the navel to above the pubis. Organs are removed through this opening. The operation takes about 1 hour. A blood transfusion may be needed. This will depend on the amount of blood lost in this operation. To avoid bruising, a drain could be placed for a few days. This operation requires about a week of hospitalization and on average a little more than a month of convalescence. All this will depend on whether or not the abdominal muscles are cut. If the muscles are not cut, the convalescence will be shorter and the resumption of physical activities will be faster. It is this method that leaves the most scars and is the most invasive.

2. Hysterectomy by laparoscopy (endoscopy)

This technique allows organs to be removed without making an incision in the abdomen. A gas is first injected into the belly using a very fine needle entered into the belly near the navel. This gas causes the belly to swell, giving enough space to cut and remove the organs. Then, three holes are made to allow the passage of the instruments necessary for the operation. A first hole one centimeter in diameter is made in the navel to allow the passage of the optical camera. Two other holes half a centimeter in diameter are made lower on each side of the belly. These holes must allow the passage of hollow tubes reserved for surgical instruments. Organs are removed either through the vagina or through the largest of the inserted tubes. Hospitalization is a maximum of four days and convalescence lasts two to three weeks. This technique requires specifically dedicated equipment and solid surgeon experience.

3. Vaginal hysterectomy

When the natural passages are wide enough and the uterus is very small, vaginal hysterectomy may be considered. The bottom of the vagina is incised and gas is injected to inflate the belly. This allows the surgeon to have enough space to manipulate these instruments.

Organs are removed this way. To be able to benefit from this technique which leaves almost no trace, it is necessary to have had sexual intercourse with penetration or even better to have already given birth. This technique is the least traumatic for the body and the convalescence is only about ten days.

Possible complications

The main complication during the operation is infusion in case of hemorrhage and wounds to other organs that are in the direct vicinity of the internal sex organs. This may result in the need for a second operation to fix the problem.

Endoscopy and vaginal techniques require increased monitoring because of the gas injected to inflate the belly. This gas could be assimilated by the blood vessels and cause complications.

Postoperative complications cannot be excluded either. Abscesses, hematomas or a urinary tract infection cannot be ruled out. But all of these problems can usually be cured with antibiotics.

Hysterectomy is an operation that causes quite a lot of blood loss. The surgeon will probably prescribe a preventive treatment to avoid the risk of phlebitis or pulmonary ambolia.